D3 rotation Flashcards
1.) What patients, in general, are recommended for antibiotic prophylaxis for prevention of bacterial endocarditis
1.) patients with highest risk of adverse outcomes
resulting from infective endocarditis
2.)7 dental procedures requiring antibiotic prophylaxis for bacterial endocarditis
2.) extraction Routine cleaning Scaling and root planning Periapical root canal treatment Fitting ortho bands Placing subgingival medications Biopsy
3.) If local anesthesia is going to be injected through non-infected tissue, is antibiotic prophylaxis required
no
4.) If ortho band placement requires antibiotic prophylaxis does the placement of ortho brackets require antibiotic prophylaxis
no
5.) Does patient require antibiotic prophylaxis for normal shedding of deciduous teeth
no
6.) Does a patient require antibiotic prophylaxis if they have trauma to the lips or oral mucosa
no
7.) 5 general Cardiac conditions associated with High Risk of Infective Endocarditis, i.e. requiring antibiotic prophylaxis
7.) prosthetic cardiac valve
Prosthetic material used for cardiac-valve repair
Previous history of Infective endocarditis
Congenital heart disease
Cardiac transplant recipient who develop valvulopathy
8.) What are the 2 indications for still prescribing antibiotic prophylaxis when the Congenital Heart Disease is repaired
8.) completely repaired CHD with prosthetic material or device during first six months after procedure
Repaired CHD with residual defects at site or adjacent to site of prosthetic patch or prosthetic device
9.) Can a person have a congenital heart condition that does not require antibiotic prophylaxis
9.) Yes, it seems if it is a non-cyanotic CHD (e.g. ventricular septal defect, atrial septal defect) or hypertropic cardiomyopathy, they no longer require antibiotic coverage
10.) If a patient has a joint replacement, do they require antibiotic prophylaxis for dental procedures where there will be significant bleeding (EXT, routine cleaning, SRP, periapical RCT, fitting ortho bands, placing Subgingival meds, biopsy)
yes
11.) What is the most common joint infection
staph
12.) Of the antibiotics we prescribe, which 2 cover a
staph infection
12.) Cephalexin and Augmentin (Cluvanic acid in the
augmentin is what kills the Staph)
13.) Of Augmentin and Cephalexin, which does Dr. Smagalski prescribe for antibiotic coverage for joint replacement patient
13.) Cephalexin
14.) Rx for pre-op Cephalexin for joint replacement pt.
14.) Cephalexin (500mg/tab) Disp: 4 (Four)
Sig: Four tabs orally two hours prior to treatment
15.) What is the adult dosage for Cephalexin
15.) 2 g
16.) Is Amoxicillin indicated for antibiotic coverage in joint replacement
16.) No. Amoxicillin alone does not cover staph infections
17.) Why would another antibiotic be prescribed for antibiotic prophylaxis of a joint replacement patient if the patient is allergic (anaphylaxis, angioedema, urticaria[hives]) to Penicillin
17.) Because cephalexin (cephalosporins) are not to be used in the those pts as 5% are cross-allergic to both
18.) What is the alternative antibiotic prophylaxis for joint replacement patient who is allergic to Penicillins
18.) Clindamycin
19.) When is Clindamycin also indicated dentally
19.) infection is anaerobic, e.g. suspect deep space infection
20.) Rx for pre-op Clindamycin for joint replacement pt.
20.) Clindamycin (300mg/tab) Disp: 2 (two)
Sig: Two tabs orally one hour prior to treatment
21.) What is the adult dose for Clindamycin
21.) 600 mg
22.) Drug of Choice for Oral Prophylaxis
22.) Amoxicillin
23.) Format for writing a prescription
23.) Line 1: Drug Name (Dose/form)
Line 2: Disp: total number or volume (written out)
to get person to their max dose/24 hr period for as long as you want them to take it
Line 3: Sig: # of med to take, route of admin, freq, special instruction
24.) Does a prescription for an antibiotic require a DEA number
24.) No, only controlled substance prescriptions require a DEA number
25.) Basic antibiotic for oral aerobic infections
25.) Pen VK
26.) When deciding how many to Disp on the
prescription, what must you figure
26.) Length of course (e.g. 7 days) Max dose/24 hrs
Mg of drug/tab
e.g. Pen VK for 7 days
Page 3 of 6
Max dose/ 24 hrs =2g = 2000mg
Mg of drug/tab=500mg/tab
Max dose/mg drug per tab = 2000mg/500mg = 4 x day 4 x 7 = 28 tabs disp
27.) Are antibiotics indicated for pain
27.) No
28.) When is antibiotic coverage indicated (list we made during lecture)
28.) signs of sinus communication after EXT
Signs of infection
Immunocompromised pt (HIV, long term steroid user [RA, SLE, severe asthmatic], transplant recipient0 Systemic signs of infection (fever)
Impaired healing (diabetes)
Extensive surgery (e.g. 5 EXTs in one appt) Location of infection (e.g. canine space) Laying a flap(e.g. older denture patient)
29.) Is age ever an indication for prescribing an antibiotic
29.) No, but it is a consideration
30.) If have a maxillary tooth EXT and desire antibiotic cover, choose which and why: Pen VK or Amoxicillin
30.) Amoxicillin. Broader spectrum than Pen VK and will kill sinus infection (e.g. H. influenza)
31.) If pt is allergic to Penicillin will they be allergic to Amoxicillin
31.) Yes, they both have β-lactam ring
32.) Antibiotic that kills the same thing as Amoxicillin (aerobes + sinus infection) as well as targeting Staph infections
32.) Cephalexin
33.) 2 examples of Cephalexin indications
33.) Joint replacement pre-dental treatment prophylaxis Pt with busted teeth and skin scrapes from bike wreck
34.) If patient has a true allergy to Penicillin/Amoxicillin (anaphylaxis, angioedema, urticaria), should they be prescribed Cephalexin
34.) No. Could be cross-allergic
35.) Clindamycin covers what bacteria
35.) both aerobic and anaerobic
36.) What infections would indicate Clindamycin
36.) Deep space infection
Long standing dental infection (note anaerobes will have fetid odor)
37.)Side effect of Clindamycin
37.) pseudomembranous colitis from C. Diff
38.) What should be our instructions if patient calls complaining of diarrhea and nausea after taking Clindamycin for a while
38.) Stop taking the Clindamycin, refer pt to PCP or Oral
Surgeon
39.) What is the only way to i.d. a C. diff infection
39.) stool culture
40.) What will the PCP or Oral Surgeon use to treat the C.diff pseudomembranous colitis caused by the Clindamycin
40.) Metranidazole/Flagill
41.) What is a side effect of Metranidazole/Flagill used to treat the C. diff pseudomembranous colitis caused by Clindamycin
41.) Neurotoxicity (tingling in extremities)
42.) What is the Disp for Clindamycin to solely reduce cost
42.) 150 mg/tab vs 300 mg/tab.
Disp 42 of the 150mg/tab
Sig: Two tabs orally three times a day
43.) What is Augmentin
43.) Amoxicillin + 125 mg Cluvanic Acid
44.) If augmentin at a low dose is not helping the patient, should you instruct the patient to just double up on the current prescription or should a new prescription be written for a higher dose of the amoxicillin in the Augmentin
44.) Write new script for higher does. Doubling current prescription could overdose pt on the Cluvanic acid
45.) When prescribing pain meds, what is the dosage and number of tabs dispensed dependent on
45.) individual patient pain control requirement
46.) NSAID preferred over Acetaminophen
46.) Ibuprofen (400 mg every 4-6 hrs as needed for pain)
47.) for pain control prescription, what special instructions should be included on the Sig line
47.) “as needed for pain” or “prn pain”
48.) Tylenol #1,#2,#3,#4 all have how much Acetaminophen and how much codeine
48.) all have 300 mg Acetaminophen Each number doubles the Codeine starting at 7.5mg Tylenol #1 = 7.5 mg Codein Tyl #2=15 mg Codeine Tyl #3=30mg Codeine Tyl #4=60mg Codeine
49.) What is a side effect of Tylenol #3
49.) vomiting (1 in 3)
50.) Is there an allergic risk with Tylenol #3
50.) Yes, due to sulfite preservative. Do not prescribe if Sulfa drug allergy
51.) What patients are Tylenol contraindicated in (list we made in lecture)
51.) alcoholics
Any liver issues (e.g. Hepatitis)
If taking other acetaminophen drugs Allergic acetaminophen
52.) What patients are Aspirin contraindicated in(list we
made in lecture)
52.) kids Bleeding problems (Hemophilia, thrombocytopenia) Pt on anticoagulants (Coumadin/Warfarin, Heparin, Prodoxil, Plavix) Pt already on aspirin Von Willibrand’s Disease Asthmatic (will trigger bronchiospasm) Aspirin allergy Pregnant Liver problems Chrone’s disease
53.) Is Tyl #3 safe in pregnancy
yes
54.) Should you ever write for Tyl #4
no
55.) Lortab and Vicadyn have what narcotic paired with Tylenol
55.) Hydrocodone
56.) What is the preferred amount acetaminophen in Lortab and Vicadyn
56.) 325 mg acetaminophen
57.) Normal hyrdrocodone/acetaminophen dosage for Lortab
57.) 7.5mg/325 mg
58.) Percocet is what narcotic paired with acetaminophen
58.) Oxycodone
59.) Med to counteract nausea
59.) Zofran
60.) Rx for Zofran
60.) Zofran (8mg/tab) Disp: 6(six)
Sig: One tab orally every 6 hrs as needed for nausea
61.) If pt is hypoglycemic and dehydrated days after an EXT and unable to take the antibiotic, what should be the protocol for treatment
61.) Take Zofran, keep down for 20 min, give sugar(e.g. juice [ no diet]) keep hydrating, get foods in (eggs, mac and cheese), then advil to aide pain control, call in hydrocodone 5 mg(lortab 5mg/325mg)
62.) What is the maximum/desired max daily dose Acetaminophen
62.) 3200mg, desire to keep below 3g/ day
63.) All prescriptions on the page are assumed for what weight adult
150 lb adult
64.) Drug, dosage, and quantity should be adjusted for each patient based on what
64.) wt Age
Procedure
65.) Antibiotic and pain med safe in pregnancy
65.) Penicillin
Tyl #3
66.) When working on a diabetic, would you prefer them to be hyperglycemic or hypoglycemic
66.) a little hyperglycemic so they have a glucose reserve for stress
